PTS 2a Mock SBA Series 2020 Paper 1 Flashcards
- A 64-year-old man presents to A & E with central chest pain that radiates to the left shoulder, nausea and sweating. He has no allergies and takes simvastatin for high cholesterol. You commence them on oxygen and administer morphine for pain relief. Your consultant asks you prescribe an appropriate antiplatelet therapy for the patient, what do you give?
A. Aspirin alone
B. Aspirin and Ticagrelor
C. Clopidogrel alone
D. Clopidogrel and Warfarin
E. Dalteparin
B. Aspirin and Ticagrelor
- Which statement best describes the pharmacology of spironolactone?
A. Inhibition of aldosterone receptor in the distal tubules
B. Inhibition of cyclooxygenase enzymes in the proximal tubules
C. Inhibition of L-type voltage-gated calcium channels in the nephron
D. Inhibition of sodium chloride transporter in the distal convoluted tubule
E. Inhibition of sodium/potassium/chloride symporter in the loop of Henle
A. Inhibition of aldosterone receptor in the distal tubules
- A patient is referred to a cardiology clinic after presenting to their GP with shortness of breath after walking for 50 metres and general fatigue. on auscultation there is an audible pan-systolic murmur at the apex. What is the most likely diagnosis?
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Mitral regurgitation
E. Tricuspid regurgitation
D. Mitral regurgitation
- An 89-year-old patient with multiple undiagnosed cardiovascular co-morbidities is brought to A&E with slurred speech, left arm weakness and a severely ataxic gait. Which underlying condition is most likely to have contributed to this presentation?
A. Atrial fibrillation
B. Cor pulmonale
C. Infective endocarditis
D. Left bundle branch block
E. Myocardial infarction
Answer A – Atrial fibrillation
This patient has the classical symptoms of a stroke. AF (A) increases the risk of stroke due to blood collecting in the atria and forming clots.
- Which of the following best describes the concept of relative risk in the context of a trial examining the efficacy of statins compared to placebo in reducing heart attacks?
A. The risk of a heart attack in the statin group was 1.65% compared to 2.67% in the placebo group, therefore statins decrease the risk of heart attack by 1.02%.
B. The risk of a heart attack in the statin group was 1.65% compared to 2.67% in the placebo group, therefore statins decrease the risk of heart attack by 61%.
C. 98 patients would need to be treated with statins to prevent 1 heart attack.
D. 98 patients would need to be treated with placebo to cause 1 heart attack.
E. If this study was conducted 100 times, these results would occur in 95 of the 100 times.
Answer B- The risk of a heart attack in the statin group was 1.65% compared to 2.67% in the placebo group, therefore statins decrease the risk of heart attack by 61%.
Statins reduce the risk of heart attack therefore it is to be expected that in the trial a smaller percentage of heart attacks to occur in the statin group compared to the placebo group. (B) describes the relative risk reduction (1.65/2.67x100 =61.%)
- Which of the following is the correct order for the electrical conduction of the heart?
A. AV node -> atria -> SA node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> ventricles
B. SA node -> ventricle -> AV node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> atria
C. bundle of His -> Purkinje fibres -> atria -> AV node -> L and R bundle branches -> ventricles→SA node
D. SA node -> atria -> AV node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> ventricles
E. SA node -> atria -> AV node -> L and R bundle branches -> Purkinje fibres -> bundle of His -> ventricles
Question 10- Answer D - SA node -> atria -> AV node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> ventricles
- Judy, a 34 year-old female, presents to the GP with symptoms of hypertension despite being on a current regimen of antihypertensive medications. The junior doctor orders appropriate blood tests and the results come back which suggest a diagnosis of Conn’s syndrome. She is scheduled to have an operation for an adrenalectomy. What medication is prescribed prior to her operation to stabilise her BP and K+ levels?
A. Aspirin
B. Furosemide
C. Ramipril
D. Spironolactone
E. Warfarin
D. Spironolactone
- Which of the following is most likely to be present on an ECG with someone who has been hyperkalaemia?
A. Narrow QRS complex
B. Small T waves
C. Tall T waves
D. Tall P waves
E. U waves
Question 18- Answer C- Tall Tented T Waves
Hyperkalaemia ECG = absent P waves, prolong PR, tall T waves and wide QRS complex.
Narrow QRS complex is seen in Atrial flutter and Junctional Tachycardia.
U waves are seen in hypokalaemia not hyperkalaemia.
- Steve, a 23-year-old male, presents to the GP with a 6 week history of diarrhoea. He tells
the GP he goes four times a day but often feels as if he has to go more. He says he is very tired, has lost weight and has general abdominal cramping. He experienced a bout of diarrhoea similar to this a year ago lasting for two months, where he also noticed blood in his stool and some mucus. However this time there is none. On examination, Steve looks pale with some swollen red patches at the corners of his mouth. What would you expect to find on colonoscopy and biopsy?
A. Continuous mucosal inflammation throughout the large bowel which stops abruptly at the ileocecal junction.
B. Mucosal inflammation limited to the rectum, with evidence of superficial ulceration and crypt abscesses.
C. Patches of transmural inflammation throughout large bowel and terminal ileum, with evidence of granulomas and deep ulceration.
D. Continuous mucosal inflammation with contact bleeding from the rectum to the descending colon at the splenic flexure, with evidence of goblet cell depletion.
E. Diffuse inflammation throughout the large bowel, with evidence of granulomas and faecal leukocytes. Crypt architecture is normal.
C. Patches of transmural inflammation throughout large bowel and terminal ileum, with evidence of granulomas and deep ulceration.
n Steve’s case, his previous flare a year ago showed some evidence of colitis (diarrhoea, tenesmus, blood in stool and excess mucus). However, with the current flare he is showing some signs of malabsorption and anaemia without visible blood in the stool (pallor, weight loss and angular cheilitis). Whilst there still maybe microscopic bleeding leaving blood in the stool that Steven may not notice, the lack of mucus in this current flare might indicate the inflammation is no longer in the large bowel.
- Jane is a 15-year-old female who has come to the GP with her mother regarding her weight. In the past month she has lost 7 kg unintentionally and has also complained of feeling excessively tired. On further questioning, Jane reveals she has also had diarrhoea three times a day for the past two months. When asked to describe her bowel movements she explains that they looked paler and smellier than usual and were difficult to flush away. Her mother is concerned, as Jane’s periods still have not started and thinks it could be linked. Given your suspected diagnosis, what is the most appropriate initial test ?
A. Faecal Calprotectin
B. Stool sample for microbiology
C. Ferritin
D. IgA tissue transglutaminase or IgA endomysial antibody
E. Erythrocyte sedimentation rate and C-reactive protein
D. IgA tissue transglutaminase or IgA endomysial antibody
for the vignette given is coeliac disease. Whilst all the blood tests would be sensible tests to order in this scenario, tTGA or EMA are specific for Coeliac disease.
It is important to note that the gold standard of diagnosis for coeliac disease is endoscopy and intestinal biopsy. Positive antibody tests are used for identifying those who are more likely to have Coeliac disease, and who therefore should be referred to gastroenterology for endoscopy and intestinal biopsy which is much more invasive.
- Trevor, a 67-year-old male, has come to the GP regarding some difficulty swallowing for three months. He explains that initially it felt like certain food like toast was getting stuck in his throat, but now softer food like mashed potato was causing him pain during swallowing for the past month. He has been treated for ‘reflux’ in the past, but feels the medication isn’t helping and that his symptoms have become worse and has noticed some persistent coughing. In the past week he has been unable to keep food down after meals and mentioned there was some blood in the vomit. Trevor drinks 3 glasses of whiskey every night and has smoked a pipe for the past 45 years. He admits his diet isn’t brilliant, having frequent takeaways and that he’s always been ‘a bit more on the heavy side’. Despite this, he thinks he might have lost around 9kg in the last month without trying. On examination, there is no gurgling heard during palpation of Trevor’s neck and no halitosis. What is the most likely diagnosis?
A. Oesophageal cancer
B. Gastric cancer
C. Pharyngeal pouch
D. Crohn’s disease
E. Peptic ulcer
A. Oesophageal cancer
The pattern of worsening dysphagia from solid food to more soft food would indicate that the underlying issue was one of a growing mass. This is supported by the sudden weight loss and vomiting soon after food. Acid reflux is a risk factor of oesophageal cancer, along with smoking, excess alcohol, and obesity. The coughing indicates that the mass is located in the upper third of the oesophagus.
- Doris has been suffering from dyspepsia for the past 4 weeks, and after trying lifestyle management her GP decides to try her on a Proton pump inhibitor (PPI).
Which cells do PPIs act on?
A. G cells
B. Parietal cells
C. Mucous neck cells
D. Chief cells
E. ECL cells
B. Parietal cells
- Alan, a 72-year-old male, has recently been diagnosed with Benign Prostatic Hyperplasia. Which of the following symptoms is he least likely to have presented with?
A. Haematuria
B. Nocturia
C. Poor stream
D. Post-micturition dribbling
E. Urgency incontinence
A. Haematuria
Whilst it is possible to experience haematuria with BPH this is not a typical symptom. Lower urinary tract symptoms associated with BPH can be categorised as storage symptoms (FUN) and voiding symptoms (SHIPP)
- A man comes in for a medication review. One of the medications he is on is tamsulosin to treat his BPH. Which of these is a potential side effect which you need to ask about?
A. Erectile dysfunction
B. Haematuria
C. Nausea and vomiting
D. Postural hypotension
E. Weight loss
D. Postural hypotension
- Which of these is not a common bacterial cause of urinary tract infections?
A. E. coli
B. Proteus mirabilis
C. Klebsiella pneumoniae
D. Staphylococcus saprophyticus
E. Streptococcus pneumoniae
E. Streptococcus pneumoniae
- A 12-year- old boy with minimal change disease presents to the nephrology clinic for a review. Which of the following clinical pictures fits correctly for minimal change disease?
A. Haematuria, hypoalbuminaemia and peripheral oedema
B. Hyperlipidaemia, haematuria and hyperalbuminaemia
C. Hypoalbuminaemia, peripheral oedema and proteinuria
D. Proteinuria, haematuria and oliguria
E. Proteinuria, hyperalbuminaemia and peripheral oedema
Answer C- Hypoalbuminaemia, peripheral oedema, proteinuria
Minimal change disease is a type of nephrotic syndrome, defined by the following features:
* Proteinuria (>3.5g/day) – damaged glomerulus more permeable → more protein come across
from blood into nephron→proteinuria
* Hypoalbuminaemia – albumin leaves blood
* Oedema (periorbital and arms) – oncotic pressure falls due to less protein in blood→lower
osmotic pressure→water driven out of vessels into tissues
* Hyperlipidaemia and lipiduria – loss of protein = less lipid synthesis → more lipids in blood →
more in urine
- A 55-year-old male is asked to attend a haematology clinic due to his recent diagnosis of chronic myeloid leukaemia. He has some initial investigations prior to his appointment. What is most likely to be found?
A. Auer rods
B. Decrease in the number of basophils
C. Increase in haemoglobin
D. Philadelphia chromosome
E. Reed-Steinburg cells
Question 40- Answer D- Philadelphia Chromosome
CML is a proliferation of the myeloid cells which are the eosinophils, basophils and neutrophils. A) Auer rods found in acute myeloid lymphoma
B) CML causes an increase in basophils not decrease
C) CML causes a decrease in haemoglobin and platelets due to the replacement of normal bone marrow cells with cancerous one.
E) Reed-Steinburg cells are found in Hodgkin’s lymphoma
- A 76-year-old female has been diagnosed Non-Hodgkin’s lymphoma. She has nodal involvement on both sides of her diaphragm. What stage is she classified under using the Ann-Arbor Classification?
A. 1
B. 2
C. 3 D. 4
E. 4+B
Question 41- Answer C- 3
The Ann Arbor Classification is used for both Hodgkin’s and Non-Hodgkin’s Lymphoma.
1. Single LN region
2. >/= 2 nodal area on the same side of the diaphragm
3. Nodes on both sides of the diaphragm
4. Disseminate e.g. metastasised to the liver
‘B symptoms’ are constitutional symptoms such as fever, weight loss and night sweats
- A 50-year-old woman is investigated for weight loss and anaemia. She has no past medical history of note. On clinical examination, the GP finds splenomegaly and pale conjunctivae. Her blood test results are below:
Haemoglobin: 10.9g/dl (12 – 165)
Platelets: 702109/l (150 – 450)
White cell count: 56.6109/l (4 – 11)
Blood film: Leucocytosis seen with all stages of granulocyte maturation seen. What is
the most likely diagnosis?
A. Acute lymphoblastic leukaemia
B. Chronic lymphocytic leukaemia
C. Chronic myeloid leukaemia
D. Myelodysplasia
E. Myeloma
Question 42- Answer C- Chronic myeloid leukaemia
Test results show the haemoglobin is slightly low, the platelets are very high and the white cell count is very high.
In CML- WCC will be very high and the haemoglobin and platelets can be higher or lower. This is because there is an increase in cell turnover of myeloblast cells which further differentiate into basophils, neutrophils and eosinophils. Leucocytosis is an increase in WBCs in the blood stream which occurs due to the abnormal proliferation of WBCs in CML.
In myeloma (E) you would expect to find monoclonal antibodies and Bence-Jones proteins.
- Which of the following is not a risk factor for a deep vein thrombosis?
A. Dehydration
B. Malignancy
C. Nausea
D. Obesity
E. Varicose Veins
Question 43- Answer D- Nausea
Risk factors for DVT are based upon Virchow’s triad: stasis of blood flow, hypercoagulability and vessel wall injury. Examples include immobility e.g. hospital bed/long haul flight, dehydration, oestrogen e.g. pregnancy, genetic clotting disorders e.g. lack of protein C, obesity e.g. atherosclerosis, age (the older you are), varicose veins, surgery, previous DVT, trauma, infection and malignancy. Note that Well’s score is used to calculate the likelihood that someone has had a DVT
- A 45-year-old man has come into hospital after recently having day surgery on his knee with a swollen calf. After taking a history the FY1 finds out that he has also recently been to America and got back 3 days ago. The most likely diagnosis is a DVT. What is the gold standard investigation?
A. CT Scan
B. D-dimer
C. Doppler ultrasound scan
D. Venography
E. XR
.
Question 44- Answer C- Doppler USS
Doppler US scan is the gold standard for DVT.
A)E) CT scan and XR are not used for investigating DVT.
B)D-dimer is carried out in someone with a suspected DVT however it has a high sensitivity and a low specificity which means that if negative it rules out a DVT but if positive it does not mean that the patient definitely has a DVT.
D) Venography used to be gold standard but it is now Doppler US scan.
- A 15-year-old girl presents to the GP with heavy periods. The GP starts the girl on the oral combined contraceptive pill but is worried that she may have developed iron deficiency anaemia as a result of the blood loss. Which of the following findings would you least expect to find in a patient with iron deficiency anaemia?
A. Brittle hair and nails
B. Koilonychia
C. Pale conjunctivae
D. Reduced reflexes
E. Systolic flow murmur
Question 45- Answer D- Reduced reflexes
Reduced reflexes are a feature of macrocytic anaemia caused by hypothyroidism (note- reduced/absent reflexes also seen in vit B12 deficiency macrocytic anaemia).
Pale skin and conjunctivae are typical signs in anaemia as is a systolic flow murmur. Brittle or spoon shaped (koilonychia) and brittle hair are signs of iron-deficiency anaemia
- A 35-year-old vegan presents to her GP with peripheral neuropathy. In her past medical history, the GP also notes that she has coeliac disease that has been troubling her over the past 2 months. She orders a blood test and finds that she has megaloblastic anaemia. What is the most likely cause?
A. Folate deficiency anaemia
B. Iron deficient anaemia
C. Fanconi anaemia
D. Sickle cell disease
E. Vitamin B12 deficient anaemia
Question 46- Answer E- Vitamin B12 deficient anaemia
Vitamin B12 anaemia is caused by a lack of vitamin B12 in the diet. Vitamin B12 is found in fish, meat, poultry, eggs and is not generally present in plant-based foods therefore a vegan diet which excludes these food products may make someone more likely to be vitamin B12 deficient. Another cause is impaired absorption.
Vitamin B12 is absorbed at the terminal ileum with the help of intrinsic factor (produced by the stomach), therefore disease of the terminal ileum is more likely to result in VitB12 Deficiency. Vitamin B12 deficiency anaemia also present with neurological symptoms such as peripheral neuropathy making it the most likely answer. The main causes of megaloblastic anaemia are vitamin B12 deficiency or folate deficiency, but folate deficiency does not present with neurological symptoms.
